Long-acting ADHD meds – what’s right for you?

As I take care of patients who have ADHD, I notice that many people don’t know very much about the medication that they or their child is taking. When I bring them in for follow-up about their medication their initial reaction is to tell me that everything is fine. But upon questioning them further I soon realize that things could be better. For instance, I might find out that the mornings may be rough, but the afternoons and evenings go smoothly. Or perhaps, mornings are great, but then around 2pm trouble may set in again, or in children’s cases, they may struggle with the last few classes of the day.

The medications that are used are in a type of delivery mechanism that attempts to lengthen the breakdown and effectiveness of the pill. Some of these medications are slower in onset but last for a 12 hour duration. Other ADHD meds come on strong but fade out quickly. I try to discuss the delivery mechanism with my patients so we can make an educated decision based on the patient’s (or parent’s) observations and needs.

There are a variety of medications used to treat ADHD. The class that is primarily used with better success is called stimulants. The two groups of stimulants that are used are classified as either methylphenidate or dextroamphetamine. Initially the medications were short acting and had to be given often through the day. The difficulty encountered was with the manner in which the medications were individually metabolized and therefore would often work differently with different patients.

Over the last 10 years, the pharmaceutical companies have worked tirelessly to develop delivery mechanisms that last longer. Great success has been achieved and most of the medications used are the longer acting medications.

Examples of long acting ADHD medications are listed below:

Concerta [methylphenidate] has a delivery mechanism that was developed with a special capsule that has several layers. The outer coating of this capsule dissolves relatively quickly and provides the initial release of the medication. Later on, a microscopic laser-drilled opening in a non-dissolving part of the capsule slowly releases the remaining dosage over a period of 6-7 hours . The non-dissolving parts of the capsule are eventually excreted in the stool. The result is an initial dosage that starts immediately. The medication may not peak for 4 to 6 hours after the initial dosage but the medication overall will last up to 12 hours. Sometimes, that initial release is not strong enough to be effective and the patient may have to supplement with a short acting medication in addition to Concerta to attain the desired effectiveness.

Focalin XR [mexmethylphenidate] releases 50% of its medication immediately for a rapid onset. The other 50% of the medication is delayed in its release and the effectiveness is boosted later in the day. However, for many people, it does not last long enough and sometimes a short acting medication is needed in the afternoon or early evening.

Daytrana [methylphenidate] is the name of a patch that is put onto the skin and within about an hour the medication starts to work and will continue to do so until the patch is removed from the skin.

Metadate CD [methylphenidate] is another popular long acting ADD medication. Its initial release is 30% immediate and 70% delayed which means that the medication will become more effective throughout the day.

Adderall XR [amphetamine /dextroamphetamine] was one of the first sustained release medication containing dextroamphetamine. It has a 50% immediate release and 50% delayed. It has now been joined by another product developed by Shire Pharmaceutical that is called Vyvanse.

Vyvanse [lisdexamfetamine] is not activated until it is absorbed by the GI system and then into the blood stream, which cuts back on the potential abuse of the medication and allows a more sustained effectiveness, therefore lasting longer.

A key point to understand is that if one medication is not working well for an individual, it is important to discuss with your physician about whether or not it’s the delivery mechanism that is causing problems. If it is determined that it is the delivery mechanism then you may need to change to another medication that might work better.

Has anyone had any experience with these long acting ADHD medications? If so, what works best for you?

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ABOUT THE AUTHOR

Donna Krutka, MD

Dr. Krutka is a board-certified pediatrician who works in private practice in Tulsa, Oklahoma. Her practice includes all ages of patients from newborns to young adults. Her areas of interest include attention...read more